1
|
Frati A, Armocida D, Tartara F, Cofano F, Corvino S, Paolini S, Santoro A, Garbossa D. Can Post-Operative Posterior Reversible Encephalopathy Syndrome (PRES) Be Considered an Insidious Rare Surgical Complication? Brain Sci 2023; 13:brainsci13050706. [PMID: 37239179 DOI: 10.3390/brainsci13050706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction: Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by neurological symptoms and distinctive neuroimaging findings. There are a few cases reported in the literature in which PRES can occur after surgery, and there is no clear direct relationship between a procedure and its debut. Methods: We performed a review of the literature by analyzing all reported cases of PRES syndrome which debuted after a surgical procedure with the aim of identifying the clinical features, the timing of the symptoms' onset and the therapy of patients suffering from this unusual surgical complication. Results: The total number of patients collected was 47, with a mean age of 40.9 years. Postoperative PRES can occur in either pediatric or adult patients (ages 4-82 years). The most frequent form of comorbidity reported was cardiovascular disease (fourteen patients, 29.78%). Sixteen patients (36%) had no relevant risk factors or comorbidities at the time of the surgical procedure. The types of surgery most correlated were cranial neuro and maxillofacial surgery (twenty-one patients, 44.68%) followed by transplant surgery (eight patients, 17%). The time of onset of PRES after surgery occurred within the first 3 weeks (mean time of onset 4.7 days), and when rapidly treated with antihypertensive and antiepileptic drugs appeared to have a reversible and benign course. Conclusion: PRES syndrome can be considered a rare complication of procedures and can occur following a wide range of surgeries, especially cranial and transplant surgery. Being able to recognize it in time and treat it ensures a full reversibility of symptoms in most cases.
Collapse
Affiliation(s)
- Alessandro Frati
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S), Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Daniele Armocida
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S), Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
- Human Neurosciences Department, Neurosurgery Division "Sapienza" University, AOU Policlinico Umberto I, 00161 Rome, Italy
| | - Fulvio Tartara
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Fabio Cofano
- Neurosurgery, Department of Neuroscience, A.O.U. Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy
| | - Sergio Corvino
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Division of Neurosurgery Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Sergio Paolini
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S), Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Antonio Santoro
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S), Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Diego Garbossa
- Neurosurgery, Department of Neuroscience, A.O.U. Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy
| |
Collapse
|
2
|
Posterior Reversible Encephalopathy Syndrome in a Patient With Primary Hyperaldosteronism (Conn Syndrome). J Neuroophthalmol 2023; 43:e9-e11. [PMID: 34629405 DOI: 10.1097/wno.0000000000001351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
3
|
Carnevale JA, Babu CS, Goldberg JL, Fong R, Schwartz TH. Visual deterioration after endonasal endoscopic skull base surgery: causes, treatments, and outcomes. J Neurosurg 2022; 136:1103-1113. [PMID: 34598134 DOI: 10.3171/2021.3.jns204378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Visual deterioration after endoscopic endonasal transsphenoidal surgery (EETS) for sellar and parasellar masses is a rare but serious complication caused by either compressive or ischemic mechanisms. Timely diagnosis and intervention may restore vision if instituted appropriately. The associated risk factors and their relation to the success of intervention are not well understood. METHODS The authors examined a series of 1200 consecutive EETS cases performed by the senior author at Weill Cornell/NewYork-Presbyterian Hospital from 2010 to 2020. Cases with postoperative visual deterioration were identified. Pre- and postoperative clinical data, mechanism of visual decline, latency to intervention, and long-term visual outcome were retrospectively collected and analyzed with appropriate statistical methods. RESULTS Twenty-one patients (1.75%) complained of early postoperative visual deterioration. The most common pathology associated with postoperative visual loss was craniopharyngioma (7.69%), followed by meningioma (5.43%) and then pituitary adenoma (1.94%). Timely intervention restored vision in 81% of patients for a 0.33% rate of permanent visual deterioration. Average time to visual deterioration was 28.8 hours, and over 70% of patients experienced vision loss within the first 13 hours. Compressive etiology (n = 11), consisting of either hematoma (n = 8) or graft displacement (n = 3), occurred 7.3 hours and 70.3 hours after surgery, respectively, and was more common in adenomas. Acute postoperative visual deterioration was more common in firm closures (4.78%) compared with soft closures (1.03%; p = 0.0006). Ischemic etiology (n = 10) occurred 10.3 hours after surgery and was more common with craniopharyngiomas and meningiomas (p = 0.08). Sixteen patients (76.2%) underwent early reoperation to explore and decompress the optic apparatus. Vision was restored to baseline after reoperation in all 11 compressive cases, whereas 6/10 ischemic cases improved with supplemental oxygen and hypervolemic hypertensive therapy (p = 0.02). Fluid expansion from 8 to 16 hours (p = 0.034) and systolic blood pressure elevation from 32 to 48 hours (p = 0.05) after surgery were significantly higher in those ischemic patients who recovered some vision compared with those with persistent visual deficits. CONCLUSIONS Visual deterioration after EETS is a rare event but can be effectively treated if acted upon appropriately and in a timely fashion. Compressive etiology is reversible with early reoperation. Ischemic etiology can be successfully treated in roughly half of cases with supplemental oxygen and hypertensive hypervolemic therapy but may result in permanent visual deterioration if not instituted appropriately or if delayed with unnecessary exploratory surgery.
Collapse
Affiliation(s)
| | | | | | | | - Theodore H Schwartz
- Departments of1Neurological Surgery
- 3Neuroscience, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| |
Collapse
|
4
|
Wong M, Rajendran S, Bindiganavile SH, Bhat N, Lee AG, Baskin DS. Posterior Reversible Encephalopathy Syndrome After Transsphenoidal Resection of Pituitary Macroadenoma. World Neurosurg 2020; 142:171-175. [PMID: 32593765 DOI: 10.1016/j.wneu.2020.06.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome is manifested by a reversible neurologic deficit such as vision loss, encephalopathy, and a posterior location, typically the occipital lobes. It is commonly thought to be related to acute, severe hypertension. CASE DESCRIPTION A 51-year-old woman presented with visual loss for several months, and a suprasellar mass was diagnosed. She underwent transsphenoidal surgery, which was complicated by cerebrospinal fluid leak, and she developed posterior reversible encephalopathy syndrome while undergoing postoperative cerebrospinal fluid drainage via lumbar catheter. Her visual acuity progressed to blindness, but blindness was reversed by discontinuation of lumbar drainage, tight blood pressure control, and high-dose steroid drip. CONCLUSIONS To our knowledge, this is only the second case of posterior reversible encephalopathy syndrome following transsphenoidal surgery to be reported in the neurosurgical or ophthalmic English language literature.
Collapse
Affiliation(s)
- Marcus Wong
- Neurological Institute, Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, USA.
| | - Sibi Rajendran
- Neurological Institute, Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Nita Bhat
- Blanton Eye Institute, Department of Ophthalmology, Houston Methodist Hospital, Houston, Texas, USA
| | - Andrew G Lee
- Kenneth R. Peak Brain and Pituitary Tumor Treatment Center, Houston, Texas, USA; Department of Ophthalmology, Weill Cornell Medicine, New York, New York, USA; Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, USA; Department of Ophthalmology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Ophthalmology, Texas A&M College of Medicine, Bryan, Texas, USA; Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Department of Ophthalmology, University at Buffalo, Buffalo, New York, USA
| | - David S Baskin
- Neurological Institute, Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, USA; Kenneth R. Peak Brain and Pituitary Tumor Treatment Center, Houston, Texas, USA
| |
Collapse
|